Tackling the scourge: Where are we now?

[Guest guest]

Tackling the scourge

Even though the exact number of the HIV/AIDS-infected in India is at best a

guesstimation, the pandemic is for real — all the government has to do is face

up to it

Sanjay Kapoor Delhi

Sushma Swaraj, health minister in the erstwhile Bharatiya Janata Party-led

coalition, is a feisty woman. With her typical bridal Banarasi saris and sindoor

(vermillion) liberally spread in the parting of her hair, she has striven to

project herself as a virtuous Indian woman (Bharatiya nari) who considers it a

blasphemy to even talk in public about sex. Her carefully-cultivated image was

" propah " from every which way you looked at it. She was seen as a pious Hindu

counterpoint to everything that was sinful, promiscuous, and smacked of a

Western mindset. Through her conservative but elaborate attire, she wanted to

show her superiority to those (in her context, read Congress president

Gandhi) who bucked the Hindu way of life.

Expectedly, in her capacity as health minister, Swaraj more or less bunged the

megatonnage of her religious fundamentalism on the nation's health policy, such

as it is. Her prudery upset earlier well-established health policy initiatives,

one of which was the country's condom programme designed to prevent the spread

of sexually-transmitted diseases (STDs) and the more politically-sensitive

pandemic of HIV/AIDS. Swaraj nursed the notion that spreading condom awareness

wasn't the right way to tackle the rampaging virus; abstinence and monogamy

were, in her reckoning, an infinitely better option — actually, the only option.

She also felt that an AIDS awareness programme that used visually-suggestive

latex prophylactics as a preventive measure would only promote promiscuity

amongst youngsters.

Former health secretary J V R Prasada Rao, who silently watched over a religious

ideology bending the nation's health policy to its will, agreed in an interview

to Hardnews ('HIV/AIDS figures can never be accurate', December 2004) that the

AIDS control programme suffered immensely because the lowly, low-tech condom is

still the best and least expensive way to control the spread of AIDS. Rao

retired from his department a relieved man, after it shed the obscurantist

idiosyncrasies of a religious ideology once the United Progressive Alliance

government took over in June this year.

The other stumbling block was a section within the BJP-led government that was,

in addition to being retrograde, fiercely xenophobic. AIDS was an issue that

gave maximum play to their fears. Swaraj's predecessor, former filmstar

Shatrughan " Shotgun " Sinha, had seen in the AIDS pandemic the spoor of an

international conspiracy. Till he was forced to change his tune, he saw

everywhere the hand of a vested interest bent upon creating a socio-medical

scare.

Sinha told Hardnews, " These NGOs were creating panic in the country on the basis

of a CIA [Central Intelligence Agency] report, while there was another report

which contradicted the CIA report findings. I know that AIDS is a money-making

racket and there was nothing that the government could do about it. " Sinha had

even refused to entertain Bill and Melinda Gates when they came to India. He

later did a volte face, saying, " What's the harm if we expect their grants and

utilise them until our health services are well-equipped? "

Such needless confusion about the health ministry's mandate has caused not a

little problem for India's AIDS programme. People in India living with HIV/AIDS

increased from 3.97 million in 2001 and 4.58 million in 2002 to 5.1 million in

2004. While the epidemic first started to spread in Tamil Nadu, Maharashtra and

Manipur, no single state can be considered entirely unaffected today. (Report

compiled by the Population Foundation of India and the Population Reference

Bureau)

After the BJP government was voted out, the new government restored sense and

priority to handling the pandemic. Among the first steps the UPA government took

was transferring the earlier chief of the National AIDS Control Organisation

(NACO) to the Planning Commission and appointing someone who has considerable

expertise in building a workable communications strategy on issues of public

concern. The new health minister, Anbumani Ramadoss, also announced that he

would appoint auditing firms like PriceWaterhouses to compile ground-level

statistics of the actual number of HIV-infected persons. The new NACO chief, S Y

Quraishi, informed Hardnews (read “The AIDS problem has moved to the general

population”, p 32) that the government was about to float a tender to hire an

auditor for this purpose.

While this decision shows, more than anything else, the government's lack of

trust in the manner of gathering statistics — which AIDS combatants use to

formulate strategy — there remains a manifest reluctance within the government

to face up to the enormity of the crisis. Notwithstanding the fact that the

diffidence might have something to do with the adverse impact that high stats

would have on India's credit ratings and tourism environment, other countries

plagued by HIV/AIDS have found merit in transparency and responsibility.

It is for this reason that most government officials take with a pinch of salt

estimations from people like Professor Rich According to Dr Yogendra Chandra,

joint director of Uttar Pradesh State Aids Control Society (UPSACS), 1,350 cases

of HIV/AIDS had been reported in UP till 2004. UP, which was earlier classified

as a " low prevalence " state, is now termed a " high vulnerable " state, according

to the new-fangled NACO nomenclature.

Chandra says that since the younger generation is more likely to be affected,

the UPSACS has prepared a document to include AIDS education as a subject for

classes 9 and 11 in all UP board colleges. As part of an awareness programme for

teenagers, Phir Milenge, a full-length feature film was shown to 7,000 students

in Lucknow alone.

NGOs have also been asked to create awareness programmes in Agra, Varanasi and

Mathura in view of the large number of tourists visiting these districts.

Ricard Feacham of the Global Fund that AIDS stats in India will eventually

surpass South Africa, where the rate of growth is today far in excess of India's

annual rate of 0.8 per cent. Some reasons for Feacham's misgivings emanate from

NGOs involved in spreading HIV/AIDS awareness. Many NGOs are ill-trained and

driven by the lure of money (HIV/AIDS work in the developing world attracts

often un-audited multimillion-dollar funding that has long overtaken the quantum

of money for other developmental work). This largesse has resulted in NGOs

amplifying incidents far beyond natural proportion (read “Unjustly damned”).

What comes clear from this miasma of half-truths and subjectivity is that no

one, within government and without, knows precisely how big the pandemic is.

United Nations figures, based on reports pouring in from 550 so-called " sentinel

sites " in India, indicate roughly 5.1 million HIV/AIDS infected, but this could

be just so much guesstimation. Since much of the evidence is anecdotal,

methodology and strategies are feel-of-the-ground.

For instance, Injecting Drug Users (IDUs) in India's culturally and

topographically distinct Northeast, the seven states of which are home to the

country's maximum number of NGOs working with HIV/AIDS, probably has its maximum

number of HIV/AIDS-infected, too. But much of this is extrapolation using

calculus.

Security experts feel that in the troubled state of Manipur, AIDS could be

intensifying the disquiet amongst the youth, who are at the vanguard of the

agitation against the Indian government. The Northeast has long had the

reputation of being easy on drugs, with many youth being habitual users.

Malcontent and addicted, they are ripe for violence.

Security experts also believe that HIV/AIDS is finding its way into the barracks

of the armed forces in the Northeast, many of whom are in close contact with the

people. Most defence personnel contract the disease through sex-workers and

unsterilised drug-use hypodermics.

The ministry of defence in New Delhi has been inundated with reports about the

high incidence of HIV/AIDS among security personnel posted in the Northeast (and

even in Jammu and Kashmir). The media recently reported the discovery of more

than 200 infected Central Reserve Police Force personnel. Prasada Rao says that

the defence forces prepare periodic reports on the issue, and treatment is

better in the defence forces than anywhere else in the country.

HIV/AIDS, not too long ago concentrated in the cities, is leaking into the

countryside, threatening a rural epidemic that India doesn't have the medical

infrastructure to tackle. " Rural infections are increasing, and a rural epidemic

is more daunting as the awareness levels are low, public health services are bad

and the stigma is much more [than in the urban areas], " says Ashok ,

director of the Bill and Melinda Gates Foundation. Furthermore, recent World

Health Organisation (WHO) findings in Delhi reveal a lax attitude to the

vectoring of the HIV/AIDS virus through non-disposable syringes.

One of the biggest areas of concern is the spread of HIV/AIDS amongt women. Take

the story of Sushma, a native of Haryana, whose husband died a year ago of AIDS.

She had no idea why her husband was shrivelling up by the day. It was only at

his deathbed that she was told what was killing her husband and the fact that he

had passed on the virus to her.

Like Sushma, there are tens of thousands of women in " high-vulnerable " areas

like Uttar Pradesh and Bihar who have been surreptitiously infected by wayward

and errant husbands. In Bihar, AIDS is known as the " Bambaiya bimari " (a Mumbai

disease caught and transported by infected truckers). Some researchers told

Hardnews that the virus is sneaking into the middleclass and lower-middleclass

families in eastern Uttar Pradesh. But the headquarters of the UP AIDS Control

Society (SACS) in Lucknow doesn't suggest a high incidence in these parts.

The biggest threat to fighting HIV remains the apprehension within government

agencies that India might run out of its stock of the critical anti-retroviral

(ARV) drugs by April 2005. On World AIDS Day on December 1 this year, the Indian

government shocked the health community by revealing that it had three months of

ARV stock. So concerned was Prime Minister Manmohan Singh that he immediately

asked the NACO boss to prepare a plan of action.

The crisis of AIDS medication has been exacerbated by problems that Indian

pharmaceutical companies, such as Cipla, Ranbaxy and Dr Reddy Laboratories, are

facing because of the coming into force of the WTO regime from January 2005.

Once this new patent regime is operational, all drugs manufactured under the

outgoing process patent regime will subjected to a penalty from international

pharmaceutical majors that produce much of the world's ARVs.

This report is supported by the Project for International Health Journalism

Fellowship Program, a collaboration of the Henry J. Kaiser Foundation and the

Bill & Melinda Gates Foundation.....

source: http://www.hardnewsmedia.com/jan2005/cstory1.php

___________

Javed Abbas

E-mail: <javedabbas_2004@...>